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Abstract
We examine the outcome measurement landscape in care leaver innovation, where many innovations to support transitions of young people leaving care fail to sustain beyond a fixed-term pilot, and fewer impact wider transition policies. Our empirical qualitative study comprises interviews with 31 senior UK children's social care policy and practice professionals, 103 interviews across five innovation-focused case studies within England with a range of public and private providers. We consider these data in relation to evaluations from a nationally diffused social care innovation. We identified three measurement landscape challenges. First, we highlight the limits of the economically oriented measurement and identify an overlooked outcome measurement demand. Second, we emphasise a need to stratify care leaver population outcomes to better reflect individuals transition through different domains of life and trajectory. Third, we identify areas of precarity around the intended use of care leaver experience. We conclude that tensions exist between the pull towards a unified approach to outcome measurement and the reality of decoupled outcome requirements and legitimacy-seeking priorities which differ according to stakeholder. These tensions entrench stagnant innovation. Recognition of roles and legitimacies that exist across the process of care leaver innovation is warranted. Opportunities for action are discussed.

Objectives
Hypertension is associated with high morbidity and mortality. The complications of hypertension disproportionately impact African American residents in Chicago's South Side neighborhood. To inform the implementation of an evidence-based multilevel hypertension management intervention, we sought to identify community member– and clinician-level barriers to diagnosing and treating hypertension, and strategies for addressing those barriers.


Methods
We conducted 5 focus groups with members of faith-based organizations (FBOs) (n=40) and 8 focus groups with clinicians and administrators (n=26) employed by community health centers (CHCs) located in Chicago's South Side.


Results
Participants across groups identified the physical environment, including lack of access to clinics and healthy food, as a risk factor for hypertension. Participants also identified inconsistent results from home blood pressure monitoring and medication side effects as barriers to seeking diagnosis and treatment. Potential strategies raised by participants to address these barriers included (1) addressing patients' unmet social needs, such as food security and transportation; (2) offering education that meaningfully engages patients in discussions about managing hypertension (eg, medication adherence, diet, follow-up care); (3) coordinating referrals via community-based organizations (including FBOs) to CHCs for hypertension management; and (4) establishing a setting where community members managing hypertension diagnosis can support one another.


Conclusions
Clinic-level barriers to the diagnosis and treatment of hypertension, such as competing priorities and resource constraints, are exacerbated by community-level stressors. Community members and clinicians agreed that it is important to select implementation strategies that leverage and enhance both community- and clinic-based resources.